Interrater Reliability in Interpretation of Neuropathic Pediatric Urodynamic Tracings: An Expanded Multicenter Study

Anne G. Dudley, Mark C. Adams, John W. Brock, Douglass B. Clayton, David B. Joseph, Chester J. Koh, Paul A. Merguerian, John C. Pope, Jonathan C. Routh, John C. Thomas, Duong D. Tu, M. Chad Wallis, John S. Wiener, Elizabeth B. Yerkes, Chelsea J. Lauderdale, Chevis N. Shannon, Stacy T. Tanaka

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Purpose: Urodynamic findings often guide treatment for neuropathic bladder and are reported as objective data points in multi-institutional trials. However, urodynamic interpretation can be variable. In a pilot study pediatric urologists interpreting videourodynamics exhibited only moderate agreement despite similar training and practice patterns. We hypothesized the pilot study variability would be replicated in a multi-institutional study. Materials and Methods: We developed an anonymous electronic survey that contained 20 scenarios, each with a brief patient history, 1 urodynamic tracing and fluoroscopic imagery. All videourodynamics were completed during routine care of patients with neuropathic bladder at a single institution. Pediatric urologists from Centers for Disease Control and Prevention Urologic Protocol sites were invited to complete an interpretation instrument for each scenario. Fleiss kappa and 95% confidence limits were reported, with Fleiss kappa 1.00 corresponding to perfect agreement. Results: The survey was completed by 14 pediatric urologists at 7 institutions. Substantial agreement was seen for assessment of fluoroscopic bladder shape (Fleiss kappa 0.73), while moderate agreement was observed for assessment of bladder safety, end filling detrusor pressure and bladder capacity (Fleiss kappa 0.50, 0.56 and 0.54, respectively). Fair agreement was seen for electromyographic synergy and presence of detrusor overactivity (Fleiss kappa 0.21 and 0.35, respectively). Conclusions: Experienced pediatric urologists demonstrate variability during interpretation of videourodynamic tracings. Subjectivity of assessment of electromyographic activity and detrusor overactivity was confirmed in this expanded study. Future work to improve the reliability of videourodynamic interpretation would improve the quality of clinical care and the quality of multi-institutional studies that use urodynamic data points as outcomes.

Original languageEnglish (US)
Pages (from-to)1337-1343
Number of pages7
JournalJournal of Urology
Issue number5
StatePublished - May 2018
Externally publishedYes

Bibliographical note

Funding Information:
This publication was supported by the National Institutes of Health/National Center for Research Resources Colorado Clinical and Translational Sciences Institute Grant UL1 RR025780. Its contents are the authors’ sole responsibility and do not necessarily represent the National Institutes of Health views.

Publisher Copyright:
© 2018 American Urological Association Education and Research, Inc.


  • neurogenic
  • observer variation
  • spinal dysraphism
  • urinary bladder
  • urodynamics


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